This comprehensive program includes an exclusive panel of physicians, utilization review, case management, bill review and quality assurance processes. Forté brings together a superior panel of physicians with our renowned utilization review and case management services. Through this combination, we assure injured workers receive the care they need, when they need it, and return to work quickly and safely. Additional information on our CompKey+ program is provided below.
To access the online provider listing for the CompKey+ network, please click the link below. For a complete listing or for assistance with the provider search, you may contact Rockport Healthcare at 800-734-4460.
What is a workers' compensation health care network (HCN)?
An organization that forms a health care provider network to provide health care services to injured employees and is certified by the Texas Department of Insurance.
What are the benefits of participating in a workers' compensation HCN?
A workers' compensation HCN focuses on providing prompt and necessary medical care to injured employees and returning them to work as soon as medically appropriate. The network determines the type of doctors who may serve as treating doctors, selects their own pre-authorization requirements and appropriate guidelines to follow. These tools will result in improved outcomes for injured workers and lower overall workers' compensation costs.
If an employer elects not to participate in a workers' compensation HCN, what rules and guidelines apply to their employees?
Employers who choose not to participate in a workers' compensation HCN will be subject to the Division of Workers' Compensation (DWC) rules and guidelines.
How do I contact CompKey+?
CompKey+ can be reached directly at 800-580-1314 or via email at firstname.lastname@example.org
. A complete list of CompKey+ departments and contacts can also be found on the Forté website at www.fortereview.com. The CompKey+ mailing address is:
7600 Chevy Chase Drive
Austin, TX 78752
What is the purpose of the Employee Notice of Network Requirements?
The Notice is used to notify employees of their employer's participation in a workers' compensation health care network. This Notice must be provided to all employees. It details what they need to do to obtain medical treatment if injured at work, in an emergency, the process for selecting a treating doctor and the employee's rights and responsibilities.
Who is responsible for distributing the Employee Notice of Network Requirements, Acknowledgement Form, map, counties and list of treating doctors to the employee?
The employer is responsible for distributing the Notice and related documents to all employees; including those who are currently injured and those who do not live in a certified GSA. The Notice and related materials may be distributed electronically or via paper.
When do the Employee Notice of Network Requirements, Acknowledgement Form, map, counties and list of treating doctors have to be distributed to employees?
The Notice and related documents must be distributed to all employees on or before an agreed upon network implementation date; within three days of a newly hired employee's start date and again when an employee is injured at work. Employees have 14 calendar days from the date they receive the Notice to review, sign and return the Acknowledgement Form to their employer. If the employee is currently injured and lives in a service area of the Network, they must select a treating doctor within these same 14 calendar days. Employees who are not currently injured do not have to select a treating doctor but must still read the Notice, sign and return the Acknowledgement Form to the employer with 14 calendar days. Employees who do not sign the Acknowledgement Form remain subject to the network.
What if the employer does not distribute the Employee Notice of Network Requirements, Acknowledgement Form, map, counties and list of treating doctors to their employees?
Employees who do not receive the Notice and related documents are not required to comply with the network requirements. The carrier will be liable for the payment of medical care for an injured employee who lives within a certified GSA but has not received the notice. The employee is not subject to the network requirements until they receive these notifications.
What if an employee does not sign or refuses to sign the Acknowledgement Form confirming they received the Notice and related documents?
An employee who refuses to sign the Acknowledgement Form will still be subject to the rules and guidelines of the network. Employers should notate in their files that the employee refused to sign the Acknowledgement Form.
What if an injured employee signs the Acknowledgement Form but does not select a treating doctor within 14 days?
The adjuster may assign a treating doctor to injured employees who do not select a treating doctor within 14 calendar days of receiving the Employee Notice of Network Requirements.
What is meant by in-network?
“In-network” applies to employees whose employer has chosen to participate in a workers' compensation health care network and the employee lives within a certified geographical service area (GSA) of the network. This also includes legacy claimants who reside within a certified GSA of the Network.
What is meant by out-of-network?
Out-of-network is a term used to refer to the status of an “in-network" employee when they receive care from a physician who is not in the network and for providers who are not part of the network. Out-of-network care must be approved by the Network prior to services being rendered.
What is meant by non-network?
Non-network applies to employees whose employer does not join a workers' compensation health care network or the employer has joined a workers' compensation health care network, but the employee does not live within a certified GSA.
In-Network/Out-of Network/Non-Network: How do these terms relate to pre-authorization and treatment guidelines?
A claimant with an “in-network” status will be subject to the pre-authorization and treatment guidelines established by the Network. This includes any “out-of-network” care sought by the claimant or directed by the treating doctor.
When could an employee seek out-of-network medical care?
The treating doctor must coordinate and direct all of the injured employee's medical care. Out-of-network care may be necessary if there is not a specialty provider in the Network from whom the employee needs medical care. The treating doctor must request and receive approval for an “out-of-network referral”. The request should be completed and submitted to the claim adjuster for review. The adjuster will coordinate the initial decision and respond to all parties. Any appeals to the decision may be made to the network. Note: Employees may seek out-of-network care in medical emergencies.
What medical care is a carrier liable for if the injured employee seeks and receives out-of-network care?
Insurance carriers are liable for out-of-network medical care when it is for an emergency; or when a referral was made from the injured employee's treating doctor and an approval was granted to an Out-of-Network provider.
What is a geographical service area (GSA)?
A designated, geographic area in Texas in which health care services from network providers are available and accessible to employees who live within a specified GSA.
What if the employer opts to use the network but some of their employees live outside of the network's certified GSA?
Employees who live outside of a certified GSA are not subject to the network. These employees are non-network and subject to DWC rules and guidelines.
Are employees who do not live in a certified GSA subject to different requirements than those laid out by the CompKey+ network?
Yes. Employees who do not live within a certified GSA are subject to the Division of Workers' Compensation (DWC) rules and guidelines. This includes the DWC's pre-authorization requirements, treatment guidelines and process for selecting and changing treating doctors.
Who has CompKey+ partnered with for their health care provider panel?
CompKey+ has partnered with Rockport Healthcare Group for the Texas Health Care Network (HCN) provider panel. Rockport can be reached at 800-734-4460 or www.rockporthealthcare.com.
Who can act as a treating doctor in the CompKey+ network?
A treating doctor in the CompKey+ network may be one of the following types of doctors:
- Family Practice
- General Practice
- Internal Medicine
- Occupational Medicine Specialists
- Industrial Medicine Clinics and Urgent Care Centers
- Specialty Care if the provider has agreed to act as the Treating Provider and the network has approved the request
- HMO Primary Treating Provider if the provider has agreed to act as the Treating Provider and the network has approved the request
What is a legacy claim?
A legacy claim is a work related claim for a compensable injury with a date of injury occurring on or before September 1, 2005, or a claim with a date of injury occurring on or after the date that the employer elected network coverage.
How will the workers' compensation health care networks affect legacy claims?
Injured employees of employers, who elect to participate in a workers' compensation health care network, will be required to transition into the network provided the injured employee lives within a certified GSA. In some situations, insurance carriers may delay injured employees transition into the network if the change would detrimentally affect the injured employee's work-related medical injury/condition and/or recovery.
Is there more than one type of legacy claim?
Yes, there are two types of legacy claims. For claims in which the employee is still employed by the employer and the employer is still insured by the carrier, the employer's decision to opt-into the network determines if the employee must participate in the Network (provided they live within a certified GSA). The second is when the employee no longer works for the employer where the injury occurred or the employer is no longer insured by the carrier who was the carrier at the time of the injury.
Can we transition all legacy claims into the CompKey+ network?
Each legacy claim should be reviewed on a case by case basis and carefully consider those injured employees who may be adversely affected by such a transition. Examples of legacy claims where special consideration should be taken include when an injured employee may be in an inpatient setting or has been scheduled for a previously preauthorized surgical or rehabilitation procedure or is close to MMI.
Do legacy claims have to go through the same notification process as other claimants?
Yes. To be subject to the Network, each and every claimant and employee must be provided the Employee Notice of Network Requirements, Acknowledgement Form, map, counties and list of treating doctors.
A GAP claim is a claim occurring between September 1, 2005 and the date that the employer elected network coverage. GAP claims are not required to participate in the HCN.
What treatments and services must be pre-authorized under the CompKey+ network?
Under the CompKey+ network, the following treatments and services must be pre-authorized.
- All surgeries
- All inpatient admissions to any facility
- All psychological/psychiatric services after the initial evaluation
- All physical and occupational therapy after the first six visits
- All work hardening/conditioning regardless of CARF status
- All chiropractic manipulations after two weeks of service
- All chronic pain management programs
- All services outside the ODG-TWC and/or ACOEM treatment guidelines unless a treatment plan was previously approved
- All stimulators, including TENS, for rental or purchase
- Any treatment for an injury or diagnosis that is not accepted by the carrier as a result of a treating doctor examination to define the compensable injury(ies)
How do I submit a pre-authorization request?
When requesting pre-authorization, please identify yourself as a CompKey Plus Network Provider, and fax the request and supporting documentation to the attention of "Pre-authorization" at 800-580-3123.
Will the CompKey+ pre-authorization requirements and treatment guidelines be applicable if the injured worker is receiving out-of-network care?
Yes. If an injured worker is receiving out-of-network care, the CompKey+ network pre-authorization requirements and treatment guidelines still apply.
Do all certified workers' compensation health care networks have the same pre-authorization requirements and treatment guidelines?
No. Each network establishes its own pre-authorization requirements and treatment guidelines. Emergency treatments and services do not require pre-authorization.
In what instances must the Division of Workers' Compensation (DWC) pre-authorization guidelines be followed?
Employees with a “non-network” status are required to adhere to the DWC pre-authorization and treatment guidelines. This includes employers who do not participate in a workers' compensation health care network, and those employees who do not “live” within a certified GSA of the Network.
Does a treating doctor have to obtain approval from the network to refer an injured employee to a specialist?
If a treating doctor is referring the injured employee to a specialist within the network, approval is not required. However, if an injured employee requires medically necessary services which are not available within the network, the treating doctor MUST seek approval for an out-of-network referral. The “Request for Out of Network Referral” should be completed and submitted to the claim adjuster for review. The adjuster will coordinate the initial decision and respond to all parties. Any appeals to the decision may be made to the network.
If the injured employee has hired an attorney regarding his/her injury, how does this affect the Network?
If the injured employee has retained the services of an attorney, CompKey+ must have a signed copy of the Release of Information form from the attorney giving permission to release any available medical records or information. The attorney's information will be noted in the CompKey+ claimant management program. Once CompKey+ has been made aware of legal representation of an injured employee, CompKey+ will no longer be able to speak directly with the claimant.
How do I file a Network complaint?
To report a complaint about any CompKey+ Network service or provider, please call, write, or email the CompKey+ Network Coordinator. The Network cannot retaliate against you, your employer, doctor, or any person filing a complaint on your behalf. To file a complaint, you must contact the Network Coordinator within 90 days after the event occurred. The CompKey+ Network Coordinator may be reached at:
7600 Chevy Chase Drive
Austin, TX 78752
When a complaint is received, you will be sent an acknowledgement letter by the Network within seven (7) calendar days. The CompKey+ Network will review and resolve your complaint within 30 calendar days of receiving the complaint. You will receive a letter informing you of the outcome of the review, which includes the specific reasons for the Network’s resolution of your complaint.
If you disagree with the Network’s resolution of your complaint, you may file a complaint with the Texas Department of Insurance (TDI). You may obtain a copy of TDI’s complaint form on the TDI website at www.tdi.state.tx.us or by mail at:
HWCN & QA Division
Mail Code 103-6A
Texas Department of Insurance
PO Box 149104
Austin, TX 78714-9104
A complaint cannot be filed with the Network over the dissatisfaction or disagreement with an adverse determination. The reconsideration procedures should be followed for adverse determinations.
If you have any questions, complaints, or suggestions about the CompKey+ program, please contact the Network Coordinator at 800-580-1314.
Which treatment guidelines does the CompKey+ network utilize?
The CompKey+ network utilizes the following treatment guidelines in the evaluation of medical services. Providers can obtain copies of these guidelines at the following websites.
- Official Disability Guidelines
- American College of Occupational and Environmental Medicine
- The Medical Disability Advisor by Dr. Presley Reed - Reed Group